Work Ability Index

Kaija Tuomi Juhani Ilmarinen Antti Jahkola Lea Katajarinne Arto Tulkki

Finnish Institute of Occupational Health Helsinki 1998

Working Group Juhani Ilmarinen, departmental director, Finnish Institute of Occupational Health Antti Jahkola, head occupational health physician, The Finnish Post Ltd Lea Katajarinne, trainer (occupational health care), Finnish Institute of Occupational Health Arto Tulkki, secretary of the project, Pension Foundation of The Finnish Post Ltd Kaija Tuomi, special researcher, Finnish Institute of Occupational Health

Computer programme Jorma Seitsamo, researcher, Finnish Institute of Occupational Health

Editors: Sirkka Rautoja and Rauni Pietiläinen Graphic designer: Tuula Solasaari-Pekki Translator: Georgianna Oja

2nd revised edition ISBN 951-802-202-X ISSN 0357-5519

Maintaining work ability – a challenge for occupational health care!
The ability to work is the basis of well-being for all of us. Nevertheless, our work ability will deteriorate unless we take care of it. Many factors affect work ability, and we can influence several of them through our own activity. We can influence both our own life-style and our work environment. Work ability cannot be measured objectively with a single instrument. It always requires an assessment based on data obtained from several different sources. A worker's own concept of his or her work ability is as important as the evaluations of experts. Together the evaluations provide the best overall picture of work ability. The work ability index is a product of research meant for practical use in occupational health care as an aid to help maintain work ability. It depicts the worker's own assessment of his or her work ability. Its agreement with the results of clinical examinations has proved to be good (Eskelinen et al. 1991). In large follow-up studies of the Finnish Institute of Occupational Health the work ability index has also reliably predicted changes in work ability in different occupational groups. The work ability index is meant to support the worker. It can be used at an early stage to help ensure the correct measures are taken to maintain work ability. The work ability index helps to determine which workers need the support of occupational health care. In this manner optimal conditions can be established to prevent a premature decrease in work ability. The work ability index is an instrument to be used in occupational health care. It is easy and quick to use, it is reproducible, the results are received quickly, and it can be used for follow-up at both the individual and group level. Its data are confidential, and at the individual level the data are used only for occupational health care purposes. The work ability index forms the basis for further measures. If needed, occupational health personnel can, in cooperation with the worker, draw up an individual program to help maintain work ability. The professional skill of safety personnel and management may be needed to help decrease risk factors at work, and the employer's support is needed to ensure any psychological and economic conditions. Activities to maintain work ability result in benefits to both the employee and the employer. It pays to maintain and work toward improving work ability at all phases of worklife. The factors that weaken work ability begin to accumulate in middle age and are seen in workers from about 45 years of age. Investing in the maintenance of work ability and functional capacity produces results already in a few years. Improved functional capacity remains with workers as they retire and enter the third phase of their life, the "third age". The "third age" can represent a meaningful, independent and active 10–20 years of life after retirement. The quality of retirement life remains good, and society benefits through lower health care expenses.

1 What is the work ability index?
The work ability index is an instrument to be used in occupational health care. It reveals how well a worker is able to perform his or her work. The work ability index can be used as one of the methods for assessing work ability in health examinations and workplace surveys. The work ability index is determined on the basis of the answers to a series of questions (form on pages 25–28) which take into consideration the physical and mental demands of work and the worker's health status and resources. The worker fills out the questionnaire before his or her interview with an occupational health professional, who collects any missing information in consultation with the worker when needed. The occupational health professional rates the responses according to the instructions, the result being a score of 7–49. The designated value depicts the worker's own concept of his or her work ability, and, according to it, the work ability level and the objectives of any measures needed to be taken are classified as follows: points work ability objective of measures _______________________________________________________________ _ 7–27 poor restore work ability 28–36 moderate improve work ability 37–43 good support work ability 44–49 excellent maintain work ability With the aid of the questionnaire the occupational health professional is able, at an early stage, to identify workers and work environments which need measures of support. Measures directed toward restoring work ability or additional evaluations of work ability are needed by those whose work ability is poor (maximum score 27). For those whose work ability is moderate (score 28–36), measures to help improve work ability are recommended. Workers with a good work ability index (score 37–43) should receive instructions on how to maintain their work ability. Those whose work ability is excellent (44–49) should also be informed about which work and life-style factors maintain work ability and which factors weaken it. The effects of the measures taken can be followed by having workers fill out the questionnaire in conjunction with periodic health examinations or other types of screening procedures. The index can also be used to predict the threat of disability in the near future. It was developed by the Finnish Institute of Occupational Health in its follow-up study of ageing municipal workers, and it was found to predict the incidence of work disability for a group of 50-year-olds. Almost two-thirds of the persons in the group with poor work ability according to the index were granted a work disability pension during the 11-year follow-up (table 1). However, more than one-third of those who were able to continue to work in the same occupation throughout the follow-up and who had a poor work ability rating initially were able to improve their work ability (table 2). The work ability index was constructed in conjunction with a follow-up study of ageing municipal workers in 1981 so that the 15% of the workers with the worst work ability score formed the poor category and the 15% with the best work ability formed the excellent category. The moderate and good classifications were divided by the median, in other words, the number of points dividing the distribution of the work ability index in half.

TABLE 1. Work disability pensioning of municipal workers between the ages of 50 and 62 years according to their work ability index at approximately 50 years of age (Tuomi 1995)
Work ability index Number of Retired on disability pension at approx. 50 years workersa of age Number % ________________________________________________________________ Men poor 287 187 65.2 moderate 710 287 40.4 good 728 203 27.9 excellent 359 64 17.8 all 2084 714 35.6 ________________________________________________________________ Women poor 359 215 59.9 moderate 934 311 33.3 good 1098 204 18.6 excellent 470 60 12.8 all 2861 790 27.6 ________________________________________________________________ aThe figures exclude those who died or received an old-age pension during the follow-up.

TABLE 2. The work ability index at approximately 50 years of age and improvement in the work ability of municipal workers who continued to work in the same occupation during the 4-year follow-up in 1981–85 and the 11-year follow-up in 1981–92: percentance of those whose work ability score had increased from a lower category to some of the higher categories
Work ability index at approx. 50 years of age in 1981 Approx. 55 years of age Number of subjects Approx. 58 years of age

Work Number of Work ability subjects ability improved, % improved, % ______________________________________________________________________ Men poor 118 37.3 8 20.0 moderate 430 15.4 54 11.1 good 542 6.8 142 7.8 a a excellent 288 104 ______________________________________________________________________ Women poor 147 34.0 8 62.5 moderate 625 16.0 105 15.2 good 803 5.0 241 3.7 a a excellent 359 159 _____________________________________________________________________ a None of the workers had moved to a higher category because this category is the highest possible.

2 Calculating the work ability index

The work ability index covers seven items, each of which is evaluated with the use of one or more questions (table 3). It is calculated by summing the points received for each item according to table 3. In the calculation it is especially important that the score for item 2 (work ability in relation to the demands of the job) be weighted according to the following instructions and that the final scores for items 3 (number of current diseases diagnosed by a physician) and 7 (mental resources) be determined according to the instructions in table 3. The best possible rating on the index is 49 points and the worst is 7 points. All the questions in the questionnaire must be answered before the index can be calculated. Half points in the final scores are rounded off to the next whole number (e.g., 28.5 is rounded to 29 points). TABLE 3. Items covered by the work ability index, the number of questions used to evaluate each item, and the scoring of the responses
Item Number of Scoring of the responses questions _____________________________________________________________________________

1 2 3

current work ability compared with the lifetime best work ability in relation to the demands of the job

1

0–10 points (value circled in the questionnaire) score weighted according to the nature of the work (formula for the calculation appears on the next page)

2

number of current diseases diagnosed by a physician

1 at least 5 diseases = 1 point (list of 51 3 diseases = 3 points diseases) 4 diseases = 2 points 2 diseases = 4 points 1 disease = 5 points no disease = 7 points (only diseases diagnosed by a physician are counted) 1 1–6 points (value circled in the questionnaire; the worst value should be chosen) 1–5 points (value circled in the questionnaire) 1, 4 or 7 points (value circled in the questionnaire) the points of the question series are added together and the sum is modified as follows: sum 0–3 = 1 point sum 4–6 = 2 points sum 7–9 = 3 points sum 10–12 = 4 points

4 5 6 7

estimated work impairment due to diseases

sick leave during the past year (12 months) own prognosis of work ability two years from now mental resources (note: item 7 refers to the worker's life in general, both at work and during leisure time)

1

1

3

_____________________________________________________________________________

Item 2 (ability in respect to demands): weighting of the response
In item 2 work ability is assessed in relation to both the physical and mental demands of the job. The response to the question is weighted according to whether the work is primarily physical or mental. The term "work ability score" refers to the number of the response circled in the questionnaire. For physically demanding work, for example, auxiliary, installation and home care work the work ability score for the physical demands of the job is multiplied by 1.5 the work ability score for the mental demands of the job is multiplied by 0.5. For mentally demanding work, for example, office, teaching and administrative work the work ability score for the physical demands of the job is multiplied by 0.5 the work ability score for the mental demands of the job is multiplied by 1.5. For work that is both physically and mentally demanding, for example, nursing, transport, dental and kitchen supervision work, the work ability score remains unchanged.

Example of the weighting of the response
Suppose that the respondent circled alternative 3 for the physical demands of his or her job and alternative 5 for the mental demands of the job. If he or she has a physically demanding job, item 2 is calculated as follows: (3 x 1.5) + (5 x 0.5), that is 4.5 + 2.5 = 7. If his or her job is mentally demanding, item 2 is calculated as follows: (3 x 0.5) + (5 x 1.5), that is 1.5 + 7.5 = 9. If he or she has a job that is both physically and mentally demanding, item 2 is calculated as follows: 3 + 5 = 8.

3 Example of how to determine the work ability index
A construction supervisor whose job is basically mentally demanding will serve as the example. When the supervisor filled out the work ability questionnaire the first time, he was 50 years old and had separated from his wife the preceding autumn. A physician had diagnosed hypertension, and he had hurt his back on a construction site the preceding winter. He considered himself somewhat overweight, and he sometimes had stomach trouble. In spite of his problems, his work ability index was good, score of 38. The supervisor's work ability index was determined from his responses to the questionnaire as follows:
Item Response Score ___________________________________________________________________________

1 2

current work ability compared with the lifetime best work ability in relation to the demands of the job

score 7

7

work ability in relation to physical demands: 2 work ability in relation to mental demands: 4 diagnosed injury to the back and hypertension (2 diseases =score of 4) (own opinion: digestive problems and overweight, but these did not receive points because they were not diagnosed by a physician) score 5 (able to work but it causes symptoms) score 4 (less than 9 days)

7 because the job was primarily mental work: (2 x 0.5) + (4 x 1.5) =1+6=7 4

3

number of current diseases diagnosed by a physician

4 5 6 7

estimated work impairment due to disease sick leave during the past year (12 months) own prognosis of work ability two years from now mental resources

5

4

score 7 (rather certain)

7

enjoys daily tasks: 3 4 active and alert: 4 full of hope for the future: 3 ____ total points: 10, so the score is 4 ____________________________________________________________________ Total score 38 Work ability index 38, good

4 Reference values
How can the reference values be used?
The reference values used for the work ability index have been taken from several investigations, and more data are continually being gathered. The reference values given on pages 13–15 present the averages and percentages of different categories of work ability index according to gender, age and occupation (tables 4–7). The reference values can be used, for example, for the following comparisons: What is the work ability of the employees in your own workplace at the age of 50, 55 and 58 years in comparison with the average work ability of municipal workers and other occupational groups at the same age? What is the percentage of workers with a poor work ability in your own workplace in comparison with the results of municipal workers, construction workers, and industrial workers? On the basis of the comparison, you can determine if the work ability of the workers in your own workplace deviates from the reference values. Of primary importance is to determine how many workers have a poor work ability in different occupations according to age group. Measures should especially be directed towards the workers with poor work ability because a large proportion of these workers may become disabled to work within the next few years if proper supportive measures are not taken. When the work ability indices are checked and supportive measures are considered, different occupational and job groups should be taken into account. As a result of the work ability follow-up, occupational health personnel can establish their own reference values for clients on the basis of their follow-ups (group follow-up form). The work ability distribution of the clients by age and occupation will form the most important reference values for occupational health personnel. The most important task of occupational health personnel is to follow the changes in work ability on the individual and group level (for example, departmental, age or occupational group) and evaluate the effectiveness of the measures that have been taken.

TABLE 4. Means of the work ability indices of 50- , 55- and 58-year-old men and women currently in municipal occupations according to work content (physically demanding, mentally demanding or a combination of both) and profile group

Gender/work content/ Age (years) profile group 50 55 58 _____________________________________________ Men 35 34 34 _____________________________________________ Physically demanding work 34 33 31 auxiliary work 33 33 31 unskilled assistants painters construction workers and streetsweepers park workers laborers installation work 35 33 31 fire fighters janitors mechanics and pipe fitters car mechanics carpenters electricians _________________________________________ Combination of physically and mentally demanding work 34 34 33 transport work 34 34 32 machine operators bus drivers other transport workers dump work 33 33 .. dental work 37 38 .. nursing work 35 36 .. psychiatric nurses _________________________________________ Mentally demanding work 39 36 36 administrative work 40 38 37 social workers office supervisors technical supervision 38 35 36 fire chiefs supervisors at construction sites physician's work 44 41 40 teaching work 38 35 34 vocational school teachers secondary school teachers

Gender/work content/ Age (years) profile group 50 55 58 _________________________________________ Women 36 35 34 _________________________________________ Physically demanding work 34 32 32 auxiliary work 34 33 31 cleaners hospital aides kitchen helpers construction workers and streetsweepers park workers home care work 34 31 33 bathers domestic helpers and housekeepers

_________________________________________

_________________________________________ Combination of physically and mentally demanding work 37 35 34 kitchen supervision 36 34 30 dental work 39 37 38 nursing work 37 35 34 child care workers practical nurses psychiatric nurses specialized nurses other nurses _________________________________________ Mentally demanding work 39 35 35 office work 38 36 35 drafting personnel typists clerks administrative work 40 37 36 social workers head ward nurses head nurses office supervisors physician's work 40 39 38 teaching work 38 35 35 vocational school teachers secondary school teachers day care center teachers _________________________________________

TABLE 5. Percentage of 50-, 55- and 58-year-old municipal workers in the work ability categories according to the workers' gender and whether the work is physically demanding, mentally demanding or a combination of both (Ilmarinen 1988, Ilmarinen et al. 1995)
gender/ Physically Physically and Mentally work ability demanding mentally demanding index* work demanding work work ______________________________________________________________________________ 50 years Men of age poor 18 20 9 moderate 40 38 21 good 32 32 39 excellent 10 10 31 Women poor 21 10 6 moderate 40 34 24 good 30 40 46 excellent 9 16 24 ______________________________________________________________________________ 55 years Men of age poor 19 18 8 moderate 47 42 37 good 28 31 43 excellent 6 9 12 Women poor 22 14 10 moderate 52 42 39 good 22 31 41 excellent 4 9 10 ______________________________________________________________________________ 58 years Men of age poor 26 21 13 moderate 50 44 37 good 20 25 31 excellent 4 10 19 Women poor 28 15 15 moderate 44 47 39 good 21 27 34 excellent 7 11 12 ______________________________________________________________________________ Age

TABLE 6. Percentage of construction workersa in the work ability categories according to their age (based on data from Matikainen et al. 1993)
Work ability Age, years index* 40–44 45–49 50–54 55–59 60–65 ______________________________________________________________________________ poor 2.4 2.8 7.0 13.5 15.7 moderate 13.1 13.8 29.3 34.6 41.2 good 60.3 64.9 52.1 44.2 35.3 excellent 24.2 18.5 11.6 7.7 7.8 ______________________________________________________________________________ total, % 100.0 100.0 100.0 100.0 100.0 total, n 252 254 242 156 51
a

Occupational groups: carpenters, building men, measuring carpenters, cement and concrete workers, renovators, pipe fitters, bricklayers, tilers, truck drivers.

TABLE 7. Percentage of workers in a middle-sized industrial enterprise in the work ability categories according to their age (based on data from Ilmarinen et al. 1996)
Work ability Age years index* 20–29 30–39 40–49 50–59 60–64 total ______________________________________________________________________________ poor – – 1.2 8.3 25.0 2.8 moderate 1.6 6.3 11.3 21.7 37.5 12.2 good 26.5 41.3 40.9 43.9 25.0 40.1 excellent 71.9 52.4 46.6 26.1 12.5 44.9 ______________________________________________________________________________ total, % 100.0 100.0 100.0 100.0 100.0 100.0 total, n 64 126 338 158 8 683

*categories of the work ability index: poor = 7–27 points moderate = 28–36 points good = 37–43 points excellent = 44–49 points

5 Practical follow-up measures

Occupational health care personnel can use the work ability index in their overall assessment of a worker's work ability and functional capacity. They consider whether, in addition to the work ability index, other evaluations, such as tests measuring physical or mental function or laboratory tests, are needed. Once a reliable assessment of a worker's work ability has been made, the occupational health personnel can determine the measures and recommendations needed to support this work ability and develop the worker's job, work conditions and work community (employee's feedback form and follow-up form for actions taken). The need for supportive measures depends on the worker's work ability and functional capacity and on his or her work conditions. If the worker's work ability is excellent, the occupational health personnel should explain which work and life-style factors help maintain and which help weaken his or her work ability. The worker is urged to continue to avoid or decrease the factors which weaken work ability. Attempts to strengthen a good work ability are supported, and it is determined whether the worker's work and life-style have features to help strengthen work ability or whether they have characteristics that threaten it. If work ability is moderate, an effort should be made to increase the worker's own initiatives to promote his or her work ability (diet, exercise, sleep and rest, social activities, and other hobbies and study). In addition a worker may need medical rehabilitation. Often a worker also needs measures to develop his or her professional knowledge and to increase and diversify his or her occupational skill. In addition any risks in the work or work environment and work organization and problems with supervisors should be corrected. If work ability is poor, the prerequisites and possibilities for rehabilitation should be determined and also whether the worker's work ability can be restored by correcting the hazards found in his or her work or work environment and by remodelling the work organization to make it more efficient. Possibilities such as job rotation, change in tasks, free work shifts and other individual solutions should be considered. The work ability index is a concrete aid to the creation of an overall picture of a worker's work ability and functional capacity and the factors affecting them. An individual worker's work ability index or the mean index of a group can be checked at suitable intervals (worker's follow-up form). In this manner the prerequisites for supporting an employee's work ability and functional capacity are improved, and through this effort the productivity of the enterprise, among other things, is increased. At the same time occupational health personnel have the possibility to develop work methods and cooperation with management, personnel administrators, foremen, and occupational safety and health groups. Activities to maintain work ability require cooperation between all the concerned parties.

For the follow-up of work ability and the assessment of associated supporting measures, the following system supporting work ability has been constructed:
determination of the work ability index and examination made by a health care professional other examinations overall assessment of work ability and functional capacity occupational health measures follow-up of measures work ability index interview by health care professional, examination of general health status, etc laboratory and other examinations other examinations, for example, focusingon physical and psychological functional capacity on the individual level on the work group level (for example, departmental, age or occupational group) feedback on work ability and functional capacity instructions for maintaining and strengthening work ability activities to maintain and strengthen work ability improving the work load and work environment (ergonomic, occupational hygiene, safety) - muscular work - difficult work postures - monotonous work movements - tools and work spaces - climatic conditions - machine use - hazardous substances improving the work community and work organization - possibilities for development - responsibility - management and supervisory work - feedback and support - use of knowledge - work schedules - lack of freedom - inspirational work improving functional capacity (physical exercise, healthy and invigorating life-style) and promoting professional skill - exercise - sleep and rest - diet and eating habits - smoking and alcohol consumption

- hobbies and other invigorating activities - maintenance and promotion of professional skill - professional and medical rehabilitation other supportive services follow-up of work ability follow-up of work and work conditions follow-up of the occupational health personnel's activities follow-up of feedback and realization activities

Confidentiality of the data
Data obtained with the questionnaire of the work ability index is strictly confidential, and they are covered by the same regulations for secrecy as the activities of health care professionals in general. The data cannot be given to anyone not employed by the occupational health unit, for example, the worker's employer, in a form that will reveal the identity of the employee or employees in question. To ensure confidentiality, it is recommended that data be presented in statistical cells comprised of 10 persons, for instance, in age or occupational groups, when sensitive topics such as health are under consideration. Filling out the questionnaire of the work ability index is always voluntary. Refusing to fill out the form must not in any way negatively influence the treatment of a worker by occupational health personnel or the employer. Occupational health professionals can use the work ability index to help promote and maintain work ability and to follow workers who must cope with a disability or illness at work. It can also be used in counseling for rehabilitation and in reference to treatment or rehabilitation and the person's participation in workplace activities that maintain work ability. When the questionnaire is given to a worker to be filled out, the worker must be informed of the purpose for which the questionnaire data will be used and also how to proceed if a need for treatment or other health care is revealed. According to ethical rules, the information must be given in written form, but should also be presented verbally. The work ability index is calculated from the data on the questionnaire, and a summary is written for the worker's personal health data file. Workers are asked to give their informed consent for the summary and the index score to be included in their health file, and generally the data will not be added without this consent. A request for the worker's consent is included for this purpose at the bottom of the form. If, however, the questionnaire data are collected for the purpose of following a worker's illness or disability or for counseling for treatment or rehabilitation, the worker's consent is not necessarily needed. The data can be recorded in the summary to the degree necessary for the activity in question. The original questionnaire form is retained with the records of the occupational health unit (in a form file or in a computer database), and it is kept separate from worker's personal health data file. Occupational health professionals are permitted access to the original detailed data when needed. The same regulations that cover occupational health care records also cover the delivery of the work ability summary and work ability index. When personal health care data are delivered, the forms and corresponding computer database must remain with the occupational health unit which collected the data. The instructions for processing, compiling, saving, and delivering occupational health care records are being updated. At the same time instructions concerning the permissible limits for retaining such documents are being drawn up, for example, for databases and for forms.

6 Feedback and follow-up

To aid the provision of feedback to the worker, a form has been devised that both explains and gives instructions for activities to maintain and promote work ability. In conjunction with the feedback, activities to promote work ability are recommended in the sample list . The back of the follow-up form for the worker contains a follow-up form meant for the use of occupational health personnel; it has been designed to aid the follow-up of recommended measures.

Sample list of measures to improve work ability
1 Improving the work load and the environment (ergonomics, occupational hygiene, safety) 11 111 112 113 114 decrease in muscular work manual carrying, lifting and moving standing work rotation other muscular work

12 decrease in difficult work postures and movements 121 stooped and twisted or other difficult work postures 122 similar repetitive movements 123 other difficult postures and movements 13 improvements in tools and work spaces 131 which tools? 132 which work spaces? 14 141 142 143 15 151 152 153 154 16 161 162 163 17 decrease in climatic hazards heat, cold or changes in temperature dryness, dampness, wetness other climatic hazards decrease in machine hazards noise vibration risk of accident other hazards related to the use of machines protection from hazardous substances mold or dusts hazardous substances, dirty conditions other hazardous substances decrease in other hazardous work loads or work conditions

2 Improving the work community and work organization (personal relations, collaboration, management) 21 211 212 213 22 221 222 223 224 23 231 232 233 234 24 241 242 243 25 251 252 253 26 261 262 263 27 271 272 273 28 281 282 283 284 increase in possibilities to develop participation in planning of one's work training related to work tasks other possibilities to develop increase or decrease in work-related responsibility possibilities to control one's work responsibility for other persons possibility to fail or take incorrect action other work responsibility development of management and supervisory skills attitude of superior toward ageing communication clarification of role description development of other management and supervisory skills development of feedback and support systems recognition and acknowledgement of value support of superior other development of management and supervisory tasks increase or decrease in use of knowledge precision in the receival of information hurried decisions other use of knowledge improvement of work schedules workbreaks part-time work other work schedules decrease in lack of freedom rush and tight schedules paced work other work restrictions increase in inspiration in work addition of diversity and enrichment of the work decrease in isolation and solitarity increase in contact and social relations increase in other forms of inspiration

29 other development of the work community and work organization 3 Improving functional capacity (physical exercise, healthy and invigorating life-style) and promoting professional skill 31 311 312 313 314 315 316 increase in physical activity increase in the person's general condition increase in musculoskeletal strength and endurance increase in motor and body control increase in flexibility relaxation exercises other physical activity

32 33 331 332 333 334 34 341 342 343 35 351 352 353 354 36 361 362 363 364

improvement in quality of sleep and rest improvement in diet and eating habits meals at the workplace (recommendations) dietary recommendations (fat, salt, sugar) weight loss (goal) other dietary and eating habits (groups, etc) decrease in smoking and alcohol consumption cessation of smoking limiting of alcohol consumption other recommendations for tobacco and alcohol use (groups, etc) promotion of hobbies cultural activities (for example, music, movies, art exhibitions) club and association activities handicrafts, woodwork, and other such hobbies other possibilities to promote hobbies maintenance and promotion of professional skills training and maintenance of professional skills complementary courses support for additional education other means to promote professional skills

37 professional and medical rehabilitation 371 job retraining 372 vocationally oriented medical rehabilitation 373 training designed to maintain work ability 374 training designed to improve work ability 375 other rehabilitative activities 38 other development of the worker's work ability and functional capacity

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WORK ABILITY INDEX Worker feedback

To be filled out by occupational health personnel ________ / ______________ Date

____________________________________________________________ Surname and first names

work ability index score

score category objective _____________________________________ 7–27 poor restore work ability 28–36 moderate improve work ability 37–43 good support work ability 44–49 excellent maintain work ability

Recommendations: WORK AND WORK CONDITIONS Improvements in work load and the work environment (ergonomics, occupational hygiene, safety) WORK COMMUNITY Improvements in the work community and work organization (personal relations, collaboration, management)

_______________________________ _______________________________ _______________________________ _______________________________

WORK ABILITY PROMOTION

____________________________ ____________________________ ____________________________ ____________________________

WORKER Improving functional capacity (physical exercise, healthy and invigorating life-style) and promoting professional skill

______________________________ ______________________________ ______________________________ ______________________________

GOOD WORK ABILITY AND HEALTH

HIGH QUALITY OF WORK AND PRODUCTION

HIGH QUALITY OF LIFE AND WELL-BEING

GOOD ABILITY AT RETIREMENT, ACTIVE AND MEANINGFUL "THIRD AGE" Planned date for the next follow-up: _________/__________

WORK ABILITY INDEX Follow-up of recommendations personnel

To be filled out by occupational health

Surname and first names ___________________________________________________________________ Work place/work site ________________________________________________________________________ immediacy: 1 within 1 month 2 within ½ year 3 within 1 year realization: 1 entirely realized 2 partially realized 3 not realized

recommendation made (time)

contents or number of recommendation

imme- when to diacy (no.) be carried out

realiza- means (or cause why not succeeded) tion (no.)

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